Chronic Disease
Prevalence and Incidence of Chronic Disease
 Chronic disease is the leading cause of death and disability among
Americans and accounts for 70% of all deaths in the United States.
National Center for Chronic Disease Prevention and Health Promotion, Chronic Disease Overview
 Almost half of all Americans have a chronic condition.
National Center for Policy Analysis, Consumer Driven Health Care
 Five chronic diseases—heart disease, cancer, stroke, chronic obstructive
pulmonary disease, and diabetes—account for more than two-thirds of
all deaths.
National Center for Chronic Disease Prevention and Health Promotion 2004, The Burden of Chronic
Diseases and Their Risk Factors
Chronic Disease
Prevalence and Incidence of Chronic Disease
One in Four Americans
Have Multiple Chronic Conditions
Partnership for Solutions 2004, Chronic Conditions: Making the case for ongoing care
Chronic Disease
Age—A Major Risk Factor
Prevalence of Selected Chronic Conditions
Among Adults Age 65 and Over, 2000-2001
Merck Institute of Aging and Health 2004, The State of Aging and Health in America
Chronic Disease
Age—A Major Risk Factor
 About 80% of the senior population has one or more chronic conditions.
Because of these conditions, 25% of them are limited in their ability to
perform activities of daily living.
Goldman et al. 2005, The Value of Elderly Disease Prevention
 The number of older Americans with chronic disabilities increased from
around 6.2 million in 1984 to 6.8 million in 1999.
Federal Interagency Forum on Aging-Related Statistics 2004, Older Americans
Chronic Disease
Age—A Major Risk Factor
Older Adults are More Likely to Have
Multiple Chronic Conditions
Partnership
for Solutions 2004, Chronic Conditions: Making the case for ongoing care
Chronic Disease
The Burden of Chronic Disease - The Human Burden
People with Chronic Conditions Are the
Heaviest Users of Health Care Services
Partnership for Solutions 2004, Chronic Conditions: Making the case for ongoing care
Chronic Disease
The Burden of Chronic Disease - The Human Burden
People With Chronic Illnesses and
Activity Limitations Have More Physician Visits
Partnership for Solutions 2004, Chronic Conditions: Making the case for ongoing care
Chronic Disease
The Burden of Chronic Disease - The Human Burden
People With Chronic Illnesses and
Activity Limitations Fill More Prescriptions
Partnership for Solutions 2004, Chronic Conditions: Making the case for ongoing care
Chronic Disease
The Burden of Chronic Disease - The Human Burden
People with Multiple Chronic Conditions
Are Much More Likely to be Hospitalized
Partnership for Solutions 2004, Chronic Conditions: Making the case for ongoing care
Chronic Disease
The Burden of Chronic Disease - The Human Burden
People with Chronic Illnesses and
Activity Limitations Have More Inpatient Stays
Partnership for Solutions 2004, Chronic Conditions: Making the case for ongoing care
Chronic Disease
The Burden of Chronic Disease - The Human Burden
Individuals with Chronic Illnesses and
Activity Limitations Have More Home Health Care Visits
Partnership for Solutions 2004, Chronic Conditions: Making the case for ongoing care
Chronic Disease
The Burden of Chronic Disease - The Human Burden
One Quarter of Individuals with Chronic Illness
Also Have Activity Limitations
Partnership for Solutions 2004, Chronic Conditions: Making the case for ongoing care
Chronic Disease
The Burden of Chronic Disease - The Human Burden
People with Multiple Chronic Illnesses
Are More Likely to Have Activity Limitations
Partnership for Solutions 2002, Chronic Conditions: Making the case for ongoing care
Chronic Disease
The Burden of Chronic Disease - The Human Burden
 In 2002, older people made up 13% of the U.S. population, yet accounted
for 36% of all hospital stays, 49% of all days of hospital care, and 50% of
all physician hours.
Alliance for Aging Research 2002, Medical Never-Never Land
 The average 75-year-old suffers from three chronic conditions and takes
five prescription medications.
Merck Institute of Aging and Health 2004, The State of Aging and Health in America
 Medicare beneficiaries with five or more chronic conditions see an average
of 14 different physicians in a year.
Alliance for Health Reform 2004, Covering Health Issues
Chronic Disease
The Burden of Chronic Disease - The Human Burden
 Medicare beneficiaries with four or more chronic conditions are 99 times
more likely to be admitted to the hospital for ambulatory care sensitive
conditions than Medicare beneficiaries without chronic conditions.
Wolff, Starfield, and Anderson 2002, Prevalence, Expenditures, and Complications of Multiple Chronic
Conditions in the Elderly
 Chronic conditions limit the activities of about 12 million seniors who live
at home.
National Center for Chronic Disease Prevention and Health Promotion 2005, Healthy Aging
 Stays in skilled nursing facilities increased from 28 per 1,000 Medicare
enrollees in 1992, to 69 per 1,000 in 2001.
Federal Interagency Forum on Aging-Related Statistics 2004, Older Americans
Chronic Disease
The Burden of Chronic Disease - The Human Burden
Distribution of Medicare Enrollees Age 65 and
Over Using Assistive Devices and/or Receiving
Personal Care for a Chronic Disability, 1984, 1989, 1994, and 1999
Federal Interagency Forum on Aging-Related Statistics 2004, Older Americans
Chronic Disease
The Burden of Chronic Disease - The Human Burden
Percentage of Medicare Enrollees Age 65 and Over Who are Unable to Perform
Certain Physical Functions, by Sex, 1991 and 2002
Federal Interagency Forum on Aging-Related Statistics 2004, Older Americans
Chronic Disease
The Burden of Chronic Disease - The Human Burden
Age-adjusted Percentage of Medicare Enrollees Age 65 and
Over Who are Chronically Disabled, by Level and
Category of Disability, 1984, 1989, 1994 and 1999
Federal Interagency Forum on Aging-Related Statistics 2004, Older Americans
Chronic Disease
The Burden of Chronic Disease - The Human Burden
Distribution of Medicare Enrollees Ages 65 and Over
Receiving Personal Care for a Chronic Disability, by Type of Care,
1984, 1989, 1994, and 1999
Federal Interagency Forum on Aging-Related Statistics 2004, Older Americans
Chronic Disease
The Burden of Chronic Disease - The Economic Burden
People with Chronic Conditions Account for
83 Percent of All Health Care Spending
Partnership for Solutions 2004, Chronic Conditions: Making the case for ongoing care
Chronic Disease
The Burden of Chronic Disease - The Economic Burden
More than Three-Fifths of Health Care Spending is on
Behalf of People with Multiple Chronic Conditions
Partnership for Solutions 2004, Chronic Conditions: Making the case for ongoing care
Chronic Disease
The Burden of Chronic Disease - The Economic Burden
 Compared to individuals with no chronic conditions, the average per capita
spending for someone with one chronic condition is more than 2.5 times
greater; with three chronic conditions is more than seven times greater; and
with five or more chronic conditions is close to 15 times greater.
Partnership for Solutions 2004, Chronic Conditions: Making the case for ongoing care
 In 2003, heart disease, stroke, cancer, diabetes and Alzheimer’s disease
cost an estimated $771 billion.
Research!America 2005, Investment in Research Saves Lives and Money
 The health care costs of a 65-year-old are typically four times greater than
those of a 40-year-old.
National Center for Chronic Disease Prevention and Health Promotion 2005, Healthy Aging
Chronic Disease
The Burden of Chronic Disease - The Economic Burden
 99% of Medicare spending is on behalf of beneficiaries with at least one
chronic condition. 96% of Medicare spending is on behalf of beneficiaries
with multiple chronic conditions.
Partnership for Solutions 2004, Chronic Conditions: Making the case for ongoing care
 Two-thirds of Medicare expenditures are for the 9.5 million beneficiaries
who have five or more chronic conditions.
Medical News Today 2005, Coping with Multiple Chronic Conditions
 The United States spends more than $26 billion annually on additional
health care costs for people over 65 who lose their ability to live
independently over the course of a single year.
Alliance for Aging Research 1999, Independence for Older Americans
Chronic Disease
The Burden of Chronic Disease - The Economic Burden
Cost of Care for Those Who Lose Independence
Alliance for Aging Research 1999, Independence for Older Americans
Chronic Disease
The Future Cost of Chronic Disease
The Number of People with Chronic Conditions
is Rapidly Increasing
Partnership for Solutions 2004, Chronic Conditions: Making the case for ongoing care
Chronic Disease
The Future Cost of Chronic Disease
 Between 2000 and 2030, the number of Americans with one or more
chronic conditions will increase by 37%—46 million people.
Partnership for Solutions 2004, Chronic Conditions: Making the case for ongoing care
 By 2020, 81 million people will have two or more chronic conditions.
Partnership for Solutions 2002, Chronic Conditions: Making the case for ongoing care
 By 2030, half of the U.S. population will have one or more chronic
conditions.
Partnership for Solutions 2004, Chronic Conditions: Making the case for ongoing care
Chronic Disease
The Future Cost of Chronic Disease
 It is projected that by 2020 the U.S. will spend $685 billion a year in direct
medical costs for persons with chronic diseases, and by 2050—$906
billion.
Hoffman and Rice 1996, Chronic Care in America
 By 2030, 20% of the population will be people age 65 and older with
chronic conditions.
Partnership for Solutions 2004, Chronic Conditions: Making the case for ongoing care
 Spending on long-term care services for the elderly is projected to increase
at least two and a half times by 2050—to $379 billion.
United States General Accounting Office 2002, Long-Term
Cancer
Prevalence and Incidence of Cancer
 More than 18 million new cases of cancer have been diagnosed in the
United States since 1990.
American Cancer Society 2004, Cancer Facts and Figures
 Approximately 1.37 million new cancer cases were expected to be
diagnosed in 2005.
American Cancer Society 2005, Cancer Facts and Figures
 The National Cancer Institute estimated that in January 2001, there were
approximately 9.8 million Americans with a history of cancer.
American Cancer Society 2005, Cancer Facts and Figures
 American men have approximately a one-in-two lifetime risk of
developing cancer. American women have approximately a one-in-three
lifetime risk.
American Cancer Society 2005, Cancer Facts and Figures
Cancer
Age—A Major Risk Factor
 Age is the major risk factor for cancer—about 76% of all cancers are
diagnosed in individuals age 55 and over.
American Cancer Society 2005, Cancer Facts and Figures
 The incidence of colorectal cancer is more than 50 times higher in people
ages 60-79 than in those under 40. 91% of new cases and 94% of deaths
from colorectal cancer occur in individuals 50 and older.
American Cancer Society 2005, Colorectal Cancer Facts and Figures
 A woman’s risk of breast cancer increases with age—about 80% of breast
cancer cases occur in women over age 50.
National Institute on Aging, Age Page: Cancer facts for people over 50
 Age is the greatest risk factor for prostate cancer with more than 70% of all
cases diagnosed in men age 65 and older.
Prostate Cancer Foundation
Cancer
The Burden of Cancer – The Human Burden
 In 2002, cancer patients made 25.3 million office visits to their physicians.
Woodwell and Cherry 2004, National Ambulatory Medical Care Survey
 In 2002, cancer patients made 2.1 million visits to hospital outpatient
departments.
Hing and Middleton 2004, National Hospital Ambulatory Medical Care Survey
 45% of middle-age men who have been diagnosed with cancer in the last
year have recurring pain. 41% of middle-age women with a history of
cancer experience recurring pain.
Pfizer 2005, The Burden of Cancer in American Adults
Cancer
The Burden of Cancer – The Human Burden
 1.3 million cancer patients were discharged from hospital inpatient stays in
2003. More than 650,000 of them were over 65.
DeFrances, Hall, and Podgornik 2005, National Hospital Discharge Survey
 Less than 20% of 65-year-olds who have been diagnosed with cancer are
free of comorbidities and physical limitations.
Joyce et al. 2005, The Lifetime Burden of Chronic Disease among the Elderly
 43% of older men and 45% of older women with a history of cancer report
some type of activity limitation.
Pfizer 2005, The Burden of Cancer in American Adults
Cancer
The Burden of Cancer – The Economic Burden
 The National Institutes of Health estimated the overall cost of cancer in
2004 was $189.8 billion. This figure includes $69.4 billion in direct
medical costs, $16.9 billion in indirect morbidity costs, and $103.5 billion
in indirect mortality costs.
American Cancer Society 2005, Cancer Facts and Figures
 Colorectal cancer treatment costs about $6.5 billion per year; breast cancer
treatment costs nearly $7 billion per year; and cervical cancer treatment
costs around $2 billion per year.
Brown, Lipscomb, and Snyder 2001, The Burden of Illness of Cancer
 Direct annual spending for prostate cancer is $3.6 billion.
Pfizer 2005, The Burden of Cancer in American Adults
Cancer
The Burden of Cancer – The Economic Burden
 The annual national cost of informal caregiving for cancer patients is an
estimated $1 billion.
Hayman et al. 2001, Estimating the Cost of Informal Caregiving for Elderly Patients with Cancer
 Every year, $38.4 billion of direct medical services is spent on cancerassociated care for community-dwelling adults.
Pfizer 2005, The Burden of Cancer in American Adults
Cancer
The Future Cost of Cancer
 Current patterns predict a doubling of cancer diagnosis from 1.3 million in
2000 to 2.6 million in 2050. At the same time, the number of cancer
patients who are age 85 and older is expected to increase four-fold.
Edwards et al. 2002, Annual Report to the Nation on the Status of Cancer
 Between 1992 and 2050, the annual number of colon cancer-related
admissions for people age 60 and older is projected to increase from
192,000 to 448,000.
Seifelden and Hantsch 1999, The Economic Burden Associated with Colon
Cancer in the United States
 By 2015, more than 300,000 new prostate cancer cases will be diagnosed
each year—a 50% increase from 2004.
Prostate Cancer Foundation
 If current trends continue, by 2050 breast cancer incidence will have
increased by approximately 60%, and colon cancer incidence will have
increased by more than 100%.
Prostate Cancer Foundation
Cardiovascular Disease: Heart Disease and Stroke
Prevalence and Incidence of Cardiovascular Disease
 Almost 25% of the population—61 million Americans—have some form
of cardiovascular disease.
National Center for Chronic Disease Prevention and Health Promotion, Preventing Heart Disease and
Stroke
 Every year, about 1.5 million Americans suffer a heart attack.
American Heart Association
 2.6% of all Americans have suffered a heart attack at some point in their
lives.
MEDTAP International 2004, The Value of Investment in Health Care
 Approximately 700,000 Americans were expected to have a stroke in 2005.
American Heart Association 2005, Heart Disease and Stroke Statistics
 4.5 Million Americans are stroke survivors
American Stroke Association
Cardiovascular Disease: Heart Disease and Stroke
Age—A Major Risk Factor
 More than 71 million Americans have one or more types of cardiovascular
disease. An estimated 27.4 million of them are age 65 and older.
American Heart Association 2006, Heart Disease and Stroke Statistics
 65% of Americans will have some form of cardiovascular disease by
retirement age.
Research!America 2005, Investment in Research Saves Lives and Money
 The average age for a first heart attack is 65.8 years for men and 70.4 years
for women.
National Center for Chronic Disease Prevention and Health Promotion 2004, Heart Disease Burden
 88% of those who die from stroke are age 65 and older. For those over 55,
the incidence of stroke more than doubles each decade.
Alliance for Aging Research 2004, Task Force on Aging: Research and funding
Cardiovascular Disease: Heart Disease and Stroke
Age—A Major Risk Factor
Prevalence of Cardiovascular Diseases in Americans
Age 20 and Older by Age and Sex
American Heart Association 2006, Heart Disease and Stroke Statistics
Cardiovascular Disease: Heart Disease and Stroke
Age—A Major Risk Factor
Prevalence of Stroke by Age and Sex
American Heart Association 2006, Heart Disease and Stroke Statistics
Cardiovascular Disease: Heart Disease and Stroke
The Burden of Cardiovascular Disease – The Human Burden
 Ten million Americans are disabled as a result of stroke and heart disease.
National Center for Chronic Disease Prevention and Health Promotion, Preventing Heart Disease and
Stroke
 More than 6 million hospitalizations a year are due to cardiovascular
disease.
National Center for Chronic Disease Prevention and Health Promotion, Preventing Heart Disease and
Stroke
 Within six years of a recognized heart attack, about 22% of men and 46%
of women will be disabled with heart failure.
American Heart Association 2006, Heart Disease and Stroke Statistics
Cardiovascular Disease: Heart Disease and Stroke
The Burden of Cardiovascular Disease – The Human Burden
 Approximately 66% of heart attack patients do not make a complete
recovery.
National Center for Chronic Disease Prevention and Health Promotion 2004, The Burden of Chronic
Diseases and Their Risk Factors
 71.5% of 65-year-olds with coronary heart disease have three or more
comorbidities and physical limitations—only 3.8% have none.
Joyce et al. 2005, The Lifetime Burden of Chronic Disease among the Elderly
 Stroke is the leading cause of disability in adults in the United States.
MEDTAP International 2004, The Value of Investment in Healthcare
Cardiovascular Disease: Heart Disease and Stroke
The Burden of Cardiovascular Disease – The Human Burden
 20% of stroke survivors require institutional care within three months after
onset and 15% to 30% are permanently disabled.
Hurst 2002, The Heart, Arteries and Veins
 Only 2.7% of 65-year-olds who have experienced a stroke are free of
comorbidities and physical limitations—66.4% have three or more.
Joyce et al. 2005, The Lifetime Burden of Chronic Disease among the Elderly
 A study of ischemic stroke survivors who were at least 65-years-old found
that at six months post-stroke 50% had some one-sided paralysis, 30%
were unable to walk without some assistance, 26% were dependent in
activities of daily living, 19% had aphasia, 35% had symptoms of
depression, and 26% were institutionalized in a nursing home.
National Heart, Lung, and Blood Institute, Framingham Heart Study
Cardiovascular Disease: Heart Disease and Stroke
The Burden of Cardiovascular Disease – The Economic Burden
Estimated Direct and Indirect Costs (in Billions of Dollars)
of Cardiovascular Diseases and Stroke
American Heart Association 2005, Heart Disease and Stroke Statistics
Cardiovascular Disease: Heart Disease and Stroke
The Burden of Cardiovascular Disease – The Economic Burden
 The estimated direct and indirect cost of cardiovascular disease in 2006 is
$403.1 billion.
American Heart Association 2006, Heart Disease and Stroke Statistic
 In 1999, Medicare spent more than $26 billion on in-patient hospital costs
for cardiovascular disease patients.
Alliance for Aging Research 2003, Task Force on Aging Research Funding
 The estimated direct and indirect cost of stroke in 2006 is $59.9 billion.
American Heart Association 2006, Heart Disease and Stroke Statistics
 The conditions and disabilities associated with stroke cost the United
States between $30 billion and $40 billion a year.
MEDTAP International 2004, The Value of Investment in Health Care
 The average cost of care for a patient up to 90 days post-stroke is $15,000.
The University Hospital, Stroke Statistics
Cardiovascular Disease: Heart Disease and Stroke
The Future Cost of Cardiovascular Disease
 Between 2010 and 2030, the number of survivors of heart disease is
expected to grow at a much faster rate than the U.S. population as a whole.
National Center for Chronic Disease Prevention and Health Promotion, A Public Health Action Plan to
Prevent Heart Disease and Stroke
 A recent study demonstrated that the cost of treating cardiovascular disease
could rise by 64% to 84% by 2025.
Steinwachs et al. 2000, The Future of Cardiology
 Coronary artery disease accounts for 51% of all heart disease, and if no
preventative drugs are made available, is projected to cost the nation $75.8
billion by 2025, up from $51.9 billion in 1999.
Steinwachs et al. 2000, The Future of Cardiology
Cardiovascular Disease: Heart Disease and Stroke
The Future Cost of Cardiovascular Disease
 By 2050, more than 1 million Americans will have a first stroke every
year. This represents a 167% increase among men and a 140% increase
among women, from 1998 incidence rates.
American Heart Association 1998, Incidence of Stroke to Skyrocket Well Into the 21st Century
 Ischemic strokes will rise to over 850,000 by 2050, and between 1998 and
2050, the incidence of strokes caused by bleeding in the brain will nearly
double.
American Heart Association 1998, Incidence of Stroke to Skyrocket Well Into the 21st Century
Diabetes
Prevalence and Incidence of Diabetes
 Diabetes is the sixth leading cause of death by disease in the United States
and a leading cause of heart disease and stroke.
Alliance for Aging Research 2004, Task Force on Aging: Research and funding
 About 1.5 million new cases of diabetes were diagnosed in people age 20
and older in 2005.
Centers for Disease Control and Prevention 2005, National Diabetes Fact Sheet
 20.8 million people—7% of the population—have diabetes.
Centers for Disease Control and Prevention 2005, National Diabetes Fact Sheet
Diabetes
Prevalence and Incidence of Diabetes
 Approximately 6.2 million people are unaware that they have diabetes.
Centers for Disease Control and Prevention 2005, National Diabetes Fact Sheet
 17 million Americans—approximately 6% of the population—have type 2
diabetes, the most common form of diabetes.
MEDTAP International 2004, The Value of Investment in Health Care
 41 million people have pre-diabetes, a condition that puts them at risk of
developing diabetes because of higher-than-normal blood glucose levels.
American Diabetes Association, Total Prevalence of Diabetes & Pre-Diabetes
 Diabetes prevalence in the United States increased by more than 60%
between 1990 and 2001.
American Diabetes Association
Diabetes
Age—A Major Risk Factor
 Approximately half of all diabetes cases are in people over age 55.
Alliance for Aging Research 2004, Task Force on Aging: Research and funding
 20.9% of the population age 60 and older—10.3 million people—have
diabetes.
National Center for Health Statistics 2005, Health
 Approximately one in five people age 65 and older are affected by
diabetes.
Merck Institute of Aging and Health 2004, The State of Aging and Health in America
Diabetes
The Burden of Diabetes – The Human Burden
 Diabetes was the cause of approximately 2.3 million hospital admissions,
14 million hospital days, and 70 million nursing home days in 1997.
Goldman et al. 2005, The Value of Elderly Disease Prevention
 Diabetes is the leading cause of kidney disease, adult-onset blindness, and
lower limb amputations. It is also a significant cause of heart disease and
stroke.
American Diabetes Association, Federal Legislative Priorities for the 109th Congress
 Diabetes is the leading cause of kidney failure; in 2002, it accounted for
44% of new cases.
Centers for Disease Control and Prevention 2005, National Diabetes Fact Sheet
Diabetes
The Burden of Diabetes – The Human Burden
 Approximately 60% to 70% of diabetics have mild to severe forms of
nervous system damage causing impaired sensation or pain in the
extremities, slowed digestion, carpal tunnel syndrome, and other nerve
problems. Almost 30% of diabetics 40 years and older have impaired
sensation in their feet.
Centers for Disease Control and Prevention 2005, National Diabetes Fact Sheet
 Nearly 82,000 people with diabetes had lower-limb amputations in 2002.
American Diabetes Association, Complications of Diabetes in the United States
Diabetes
The Burden of Diabetes – The Human Burden
 Diabetic retinopathy causes between 12,000 and 24,000 new cases of
blindness every year.
American Diabetes Association, Complications of Diabetes in the United States
 48.5% of 65-year-olds with diabetes have three or more comorbidities and
physical limitations—less than 10% have none.
Joyce et al. 2005, The Lifetime Burden of Chronic Disease among the Elderly
Diabetes
The Burden of Diabetes – The Economic Burden
 One in every 10 health care dollars is spent on diabetes and its
complications.
American Diabetes Association, Federal Legislative Priorities for the 109th Congress
 Diabetes cost $132 billion in direct and indirect costs,
in 2002 dollars. This did not include the costs of its complications.
American Diabetes Association, National Diabetes Fact Sheet
 In 2002, people with diabetes had medical expenditures that were 2.4 times
higher than those without the disease.
American Diabetes Association 2003, Economic Costs of Diabetes
 In 2002, the nation spent $13,243 on every person with diabetes, compared
to only $2,650 on every person without diabetes.
American Diabetes Association 2003, Economic Costs of Diabetes
Diabetes
The Burden of Diabetes – The Economic Burden
 Diabetes consumes 25% of Medicare’s annual budget.
Research!America 2005, Investment in Research Saves Lives and Money
 In 2002, the cost of medications to treat diabetes was $7.3 billion.
PhRMA 2003, Diabetes and Pharmaceutical Spending
 Diabetic eye diseases consume 25% of eye disease-related health care
services.
The Picture of Value: Medical Imaging, Medical Imaging Helps Employers Defeat
Diabetic Eye Disease
Diabetes
The Future Cost of Diabetes
 The number of Americans with diabetes is growing at a rate of 8% a year.
American Diabetes Association, Federal Legislative Priorities for the 109th Congress
 Conservative estimates predict that diabetes prevalence will increase 165%
between 2000 and 2050.
Boyle et al. 2001, Projections of Diabetes Burden Through 2050
 By 2030, more than 30 million Americans could have diabetes—71%
higher than in 2000.
Wild et al. 2004, Global Prevalence of Diabetes
 Without intervention, one in three people born in 2000 will develop
diabetes during their lifetime.
U.S. Department of Health and Human Services 2004, Revised Definition Means Millions More Have PreDiabetes
Diabetes
The Future Cost of Diabetes
 The annual cost of diabetes, in 2002 dollars, could rise to an estimated
$156 billion by 2010, and $192 billion by 2020.
American Diabetes Association 2003, Economic Costs of Diabetes in the U.S.
 The costs of complications for type 2 diabetics over a 30-year period are
estimated at $47,240 per patient.
Caro, Ward, and O’Brien 2002, Lifetime Costs of Complications Resulting from Type 2 Diabetes
 The number of people age 75 and older with diabetes is projected to
increase from 2 million in 2000 to 8.6 million in 2050.
Boyle et al. 2001, Projection of Diabetes Burden
 An estimated 41 million people between the ages of 40 and 74 have prediabetes, and most will develop type 2 diabetes within 10 years.
American Diabetes Association, Pre-Diabetes
Neurological Disease: Alzheimer’s and Parkinson's Disease
Prevalence and Incidence of Neurological Disease
 4.5 million Americans suffer from Alzheimer’s disease. That number has
more than doubled since 1980.
Hebert et al. 2003, Alzheimer Disease in the US Population
 360,000 new cases of Alzheimer’s disease are diagnosed every year—980
every day, 40 every hour.
Cummings and Cole 2002, Alzheimer Disease
 Parkinson’s disease is the second most common neuro-degenerative
disease in the United States, second only
to Alzheimer’s disease.
National Institute of Neurological Disorders and Stroke 2004, Parkinson’s Disease
Neurological Disease: Alzheimer’s and Parkinson's Disease
Prevalence and Incidence of Neurological Disease
 As many as 1 million Americans suffer from Parkinson’s disease.
Parkinson’s Disease Foundation, Ten Frequently-Asked Questions about Parkinson’s Disease
 Every nine minutes a new Parkinson’s case is diagnosed— 60,000 new
cases every year.
Parkinson’s Action Network, About Parkinson’s Disease
Neurological Disease: Alzheimer’s and Parkinson's Disease
Age—A Major Risk Factor
 The greatest risk factor for Alzheimer’s disease is age. One in 10 people
over 65, and nearly half of those over 85, have the disease.
Alzheimer’s Association, Statistics About Alzheimer’s Disease
 Beneficiaries with Alzheimer’s disease account for 34% of Medicare
spending but make up only 12.8% of the 65 and older population.
The Lewin Group 2004, Saving Lives, Saving Money
 Parkinson’s disease affects one in every 100 people over the age of 60.
Alliance for Aging Research, Aging Statistics
 The average age of onset for Parkinson’s is 60-years-old.
Parkinson’s Action Network, What is Parkinson’s Disease?
Neurological Disease: Alzheimer’s and Parkinson's Disease
The Burden of Neurological Disease – The Human Burden
 Alzheimer’s disease advances at widely different rates and the length of
the illness can vary from three to 20 years. The areas of the brain that
control memory and thinking skills are affected first. As the disease
progresses, cells die in other areas of the brain, leaving the person
eventually needing complete care.
Alzheimer’s Association
 Almost half of all people with Alzheimer’s disease have four or more
chronic conditions.
Partnership for Solutions 2002, Alzheimer’s Disease: The impact of multiple chronic conditions
 Approximately three quarters of Alzheimer’s patients are admitted to a
nursing home within five years of diagnosis.
PhRMA 2004, Medicines Reduce the Burden of Alzheimer’s Disease
Neurological Disease: Alzheimer’s and Parkinson's Disease
The Burden of Neurological Disease – The Human Burden
 By the time symptoms of Parkinson’s disease are apparent, as much as
80% of dopamine-producing cells have been damaged.
Research!America 2005, Investment in Research Saves Lives and Money
 As Parkinson’s progresses, substantial disability—including the inability to
maintain balance, walk, speak, and move—makes assisted living and
nursing home care necessary.
Parkinson’s Action Network, About Parkinson’s Disease
 An estimated 38% of Parkinson’s patients suffer from falls; 13% fall more
than once a week.
Parkinson’s Action Network, About Parkinson’s Disease
Neurological Disease: Alzheimer’s and Parkinson's Disease
The Burden of Neurological Disease – The Economic Burden
 Alzheimer’s disease is draining more than $100 billion annually from the
nation’s economy, costing American businesses $61 billion a year.
Alliance for Aging Research 2004, Task Force on Aging: Research and funding
 The cost of care for a person with Alzheimer’s disease in a facility is
approximately $64,000 per year.
Alliance for Aging Research 2004, Task Force on Aging: Research and funding
 Medicare spends $91 billion each year on caring for those with
Alzheimer’s disease.
Alzheimer’s Association
Neurological Disease: Alzheimer’s and Parkinson's Disease
The Burden of Neurological Disease – The Economic Burden
 State and federal Medicaid spending on nursing home care for
beneficiaries with Alzheimer’s disease was $19 billion in 2000.
The Lewin Group 2004, Saving Lives, Saving Money
 Parkinson’s disease costs our society at least $25 billion annually.
Parkinson’s Action Network, About Parkinson’s Disease
 Drug therapy for Parkinson’s disease costs more than $6 billion a year.
Costs such as rehabilitation and home care can run as high as $150,000 per
patient per year.
Mayo Clinic, Parkinson’s Disease Information
 The costs for assisted living and nursing home care of a single Parkinson’s
patient can cost as much as $100,000 per year.
Parkinson’s Action Network, About Parkinson’s Disease
Neurological Disease: Alzheimer’s and Parkinson's Disease
The Future Cost of Neurological Disease
 By 2050 as many as 16 million people could be affected by Alzheimer’s
disease.
Hebert et al. 2003, Alzheimer Disease in the U.S. Population
 As the United States population ages, researchers estimate that the
prevalence of Alzheimer’s disease will come close to quadrupling over the
next 50 years, when one in 45 people may be living with the disease.
Brookmeyer, Gray, and Kawas 1998, Projections of Alzheimer’s Disease in the United States
 The number of Medicare claims for Alzheimer’s disease treatment grew by
250% during the 1990s, and is expected to increase by 300% over the next
10 years.
Peck 2004, Alzheimer’s Disease Costs Expected to Triple
Neurological Disease: Alzheimer’s and Parkinson's Disease
The Future Cost of Neurological Disease
 Medicare spending for those with Alzheimer’s disease will triple by
2015—to $189 billion from $62 billion in 2000. By 2050, Medicare will be
spending more than $1 trillion on beneficiaries with Alzheimer’s and
related dementias.
The Lewin Group 2004, Saving Lives, Saving Money
 According to the U.S. Census Bureau, the prevalence of Parkinson’s
disease will grow to between 1.3 million and 1.7 million by 2040.
Lilienfeld and Perl 1993, Projected Neurodegenerative Disease Mortality in the United States
Today’s Older Population
Number of People Age 65 and Over, by Age Group,
Selected Years 1990-2000 and Projected 2010-2050
Federal Interagency Forum on Aging-Related Statistics 2004, Older Americans
Today’s Older Population
 One out of every eight people—approximately 12.4% of the population—
is an older person.
Administration on Aging 2004, A Profile of Older Americans
 Every day, more than 6,000 Americans celebrate their 65th birthday.
Alliance for Aging Research 1999, Independence for Older Americans
 In 2004, there were an estimated 60,800 centenarians (those age 100 and
older) in the United States.
United States Census Bureau, National Population Estimates
 Since 1900, the 65 and older population has doubled three times.
Friedland and Summer 2005, Demography Is Not Destiny
Today’s Older Population
 During the twentieth century, the population of oldest-old Americans
(those age 85 and older) grew from just over 100,000 to 4.2 million.
Federal Interagency Forum on Aging-Related Statistics 2004, Older Americans
 The number of people age 100 and older increased 36% between 1990 and
2003— growing from 37,306 to 50,639.
Administration on Aging 2004, A Profile of Older Americans
Life Expectancy
Life Expectancy at Ages 65 and 85, by Sex,
Selected Years 1900-2001
Federal Interagency Forum on Aging-Related Statistics 2004, Older Americans
Life Expectancy
 During the twentieth century, life expectancy at birth increased from 48 to
74 years for men and from 51 to almost 80 years for women.
National Center for Health Statistics 2004, Health
 The average life expectancy of those who reach age 65 is close to 18
additional years, six years longer than it was in 1900.
Federal Interagency Forum on Aging-Related Statistics 2004, Older Americans
Life Expectancy
Americans are Living Longer
Partnership for Solutions 2004, Chronic Conditions: Making the case for ongoing care
Future Demographics
 On January 1, 2011, as the baby boomers begin to celebrate their 65th
birthdays, 10,000 people will turn 65 every day—this will continue for 20
years.
Alliance for Aging Research
 By 2030, the number of older Americans is projected to have more than
doubled to over 70 million—representing nearly 20% of the population.
Federal Interagency Forum on Aging-Related Statistics 2004, Older Americans
 The 65 and older population is projected to increase to between 80 and 90
million by 2050, and the 85 and older population is projected to increase to
close to 21 million.
Federal Interagency Forum on Aging-Related Statistics 2004, Older Americans
 By 2045, the number of centenarians in the United States is projected to
reach 757,000.
United States Census Bureau, Projections of the Total Resident Population
Chronic Disease
The Human Value
Decline in Disability Rates for People
Aged over 5 Years, 1982-2000
MEDTAP International 2004, The Value of Investment in Health Care
Chronic Disease
The Human Value
 Each new drug approved between 1970 and 1991 saved an average of
11,200 life-years in 1991.
Lichtenberg 2004, Longer Living Through Chemistry
 The share of elderly with impairments in their ability to live independently
went down between 1% and 1.5% annually between 1984 and 2004
compared to the historical annual decline in chronic disability of 0.6%
between 1910 and 1985.
Cutler 2004, Are the Benefits of Medicine Worth What We Pay for It?
Chronic Disease
The Economic Value
 Between 1980 and 2000, annual age adjusted per person health care costs
increased by $2,254 (102%) but were accompanied by significant health
gains including
• A 16% decline in annual death rates;
• A 4% increase in life expectancy from birth;
• A 25% decline in disability rates for people over 65-years-old; and
• A 56% decline in the number of hospital days.
MEDTAP International 2004, The Value of Investment in Health Care
 The United States would have spent $634 billion less on health care in
2000 without many of the improvements in health and the associated
investments that were seen between 1980 and 2000. However, there would
have been 470,000 more deaths, 2.3 million more disabled, and 206
million more days in the hospital.
MEDTAP International 2004, The Value of Investment in Health Care
Chronic Disease
The Economic Value
 Increased longevity added about $3.2 trillion per year to national wealth
between 1970 and 2000, an uncounted value equal to approximately half of
the average annual GDP during that period.
Murphy and Topel 2005, The Value of Health and Longevity
 During the twentieth century, cumulative gains in life expectancy, for both
men and women, were worth over $1.2 million per person.
Murphy and Topel 2005, The Value of Health and Longevity
 According to Dr. David Cutler of Harvard, current health technologies
return, on average, $4 in approximate life value for every medical dollar
spent.
Warner 2004, Boomer Health Care Dilemma
Chronic Disease
The Economic Value
 A $1 increase in spending on pharmaceuticals is associated with a $3.65
reduction in hospital-care expenditures.
Lichtenberg 1996, Do (More and Better) Drugs Keep People out of Hospitals?
 Every $1 invested in newer medications saves $7 in other costs.
Lichtenberg 2002, Benefits and Costs of Newer Drugs
 Spending $11,000 on general medical care adds an average of one year of
life. Spending only $1,345 on pharmaceutical research and development
yields the same return.
Lichtenberg 1996, Do (More and Better) Drugs Keep People out of Hospitals?
 Analysis suggests that in the past 20 years, each additional dollar spent on
health care services produced health gains valued at between $2.40 and $3.
MEDTAP International 2004, The Value of Investment in Health Care
Chronic Disease
The Future Value
 Medicare could save $26 billion per year if currently healthy older people
were able to remain fully independent over the course of a single year.
Alliance for Aging Research 1999, Independence for Older Americans
 Using newer drugs could lower overall health expenses by as much as
$111 per person, per condition, for the general population, and $155 for
Medicare beneficiaries.
Lichtenberg 2002, Benefits and Costs of Newer Drugs
Cancer
The Human Value
 Cancer mortality declined more than two percent in 2003, a continuation of
the decline that began in 1990.
National Center for Health Statistics 2005, Health
 The five-year survival rate for all cancers diagnosed between 1995 and
2000 was 64%, up from 50% between 1974 and 1976.
American Cancer Society 2005, Cancer Facts and Figures
 Treating cancer patients with oral medicine versus intravenous
chemotherapy resulted in a two-thirds reduction in hospital time and a
greater than 50% reduction in costly medication side effects.
Twelves 2001, Oral Chemotherapy Saves Resources and Time
Cancer
The Human Value
 Intensity modulated radiation therapy (IMRT) precisely maps and targets
tumors with better tumor control and fewer side effects than other forms of
radiation. In one study, IMRT increased the success rate of tumor
reduction from 43% to 96% and reduced complications from 10% to 2%.
Brown 2002, Cancer in the Crosshairs
 A 2002 study found that image-guided percutaneous needle biopsies are
between three and seven times more cost-effective than open surgical
biopsies, require a shorter procedure time, result in fewer infections, and
allow earlier treatment if cancer is found.
Jelinek et al. 2002, Diagnosis of Primary Bone Tumors with Image-Guided Percutaneous Biopsy
Cancer
The Economic Value
 A drug for testicular cancer that cost an estimated $56 million to develop
led to a sharp increase in survival rate and an annual return of $166 million
in treatment savings.
Research!America 2005, Investment in Research Saves Lives and Money
 Every additional dollar spent on overall breast cancer treatment has
produced health gains valued at $4.80.
MEDTAP International 2004, The Value of Investment in Health Care
 Surgical biopsy for lumps in the breast was found by one study to cost two
and a half to three times more than image-guided core-needle biopsy ($698
versus $243).
Burkhardt and Sunshine 1999, Core-Needle and Surgical Breast Biopsy
 Every additional dollar spent on newer, less toxic hormonal therapy for
breast cancer patients has produced health gains valued at between $27.03
and $36.81.
MEDTAP International 2004, The Value of Investment in Health Care
Cancer
The Economic Value
 Use of tamoxifen, a drug used to treat breast cancer, has resulted in a direct
cost savings of $41,372 per year of life gained in women 35- to 49-yearsold, $68,349 in women 50- to 59-years-old, and $74,981 in women 60 to
69.
Joint Economic Committee 2000, The Benefits of Medical Research and the Role of NIH
 Virtual colonoscopy is more efficient at detecting cancerous polyps than
standard colonoscopy without imaging, and costs $500–$1,500 less.
The Picture of Value: Medical imaging, Virtual Colonoscopy
 A drug that can reduce the risk of breast cancer in high-risk women costs
approximately $1,050 per year. The average cost per year for surgery or
other invasive methods of treating breast cancer is $14,000.
PhRMA 2001, The Value of Medicines
Cancer
The Future Value
 Medical research that resulted in a one-fifth reduction in deaths from
cancer would be worth $10 trillion to Americans—double the national
debt.
The Lasker Foundation 2000, Exceptional Returns
 A modest 1% reduction in cancer mortality would be worth close to $500
billion. A cure for cancer (if one is feasible) would be worth around $50
trillion.
Murphy and Topel 2005, The Value of Health and Longevity
 Widespread use of cancer vaccines could result in a cure of
melanoma/renal cell carcinomas and a 25% boost in survival for all other
cancers.
Shekelle et al. 2000, Identifying Potential Health Care Innovations for the Elderly of the Future
 Widespread use of selective estrogen receptor modulators could result in
an approximately 30% decrease in breast cancer.
Shekelle et al. 2000, Identifying Potential Health Care Innovations for the Elderly of the Future
Cancer
The Future Value
 A new DNA-based test for cervical cancer could save an estimated $1
billion a year by providing more accurate diagnosis.
AdvaMed, Medical Technology: Saves and improves lives
 Widespread use of telomerase inhibitors could result in a 50% cure rate
and a 25% prolongation of life for 50% of eligible patients with solid
tumors.
Shekelle et al. 2000, Identifying Potential Health Care Innovations for the Elderly of the Future
 If the one million surgical breast biopsies performed annually were instead
performed using image-guided needle core biopsy, the total savings could
be $1.6 billion a year.
Burkhardt and Sunshine 1999, Core-Needle and Surgical Breast Biopsy
Cardiovascular Disease: Heart Disease and Stroke
The Human Value
 About two-thirds of reduced mortality from cardiovascular disease is a
result of medical interventions.
Cutler 2004, Are the Benefits of Medicine Worth What We Pay For It?
 Increased use of non-acute medications in primary and secondary
prevention explains about one-third of the total reduction in cardiovascular
disease mortality since 1950.
Cutler 2004, Your Money or Your Life?
Cardiovascular Disease: Heart Disease and Stroke
The Human Value
Death Rates for Coronary Heart Disease, 1950-1998
National Center for Chronic Disease Prevention and Health Promotion 2003, The
Burden of Chronic Disease and the Future of Public Health
Cardiovascular Disease: Heart Disease and Stroke
The Human Value
 Mortality rates in the first three months after a heart attack have fallen by
about 75%.
Cutler 2004, Are the Benefits of Medicine Worth What We Pay for It?
 Since 1950, reduction in heart disease mortality has added more than three
and a half years to the expected lifetimes of both men and women.
Murphy and Topel 2005, The Value of Health and Longevity
 About 70 percent of the survival improvement in heart attack mortality
resulted from changes in technology.
Cutler and McClellan 2001, Is Technological Change in Medicine Worth It?
Cardiovascular Disease: Heart Disease and Stroke
The Human Value
 Glycoprotein inhibitors have been shown to reduce the risk of death, a
second heart attack, or the need for revascularization by 48% to 52% in
patients who have suffered a first heart attack.
MEDTAP International 2004, The Value of Investment in Health Care
 Primary angioplasty reduces 30-day mortality risk by 34% to 50%.
MEDTAP International 2004, The Value of Investment in Health Care
 Statin treatment soon after an acute heart attack reduces the risk of fatal
heart disease or a recurrent heart attack by 24%.
MEDTAP International 2004, The Value of Investment in Health Care
Cardiovascular Disease: Heart Disease and Stroke
The Human Value
 Use of beta blockers to treat high blood pressure in congestive heart failure
patients reduced death rates by 35%.
Winslow 2001, GlaxoSmithKline’s Coreg Benefits Heart Patients in Two Big Studies
 A blood thinning drug was found to reduce the risk of heart attack, stroke,
and cardiovascular disease by 20% in patients with acute coronary
syndrome when given in addition to aspirin.
Salim et al. 2001, Effects of Clopidogrel
 Between 1980 and 2000, stroke mortality rates fell from 96.2 to 60.8 per
100,000 persons.
MEDTAP International 2004, The Value of Investment in Health Care
Cardiovascular Disease: Heart Disease and Stroke
The Human Value
 Ischemic stroke patients treated with t-PA (a drug used to treat blood clots)
within three hours of onset are 33% more likely to be free of disability
three months after treatment.
Broderick 1998, Practical Considerations in the Early Treatment of Ischemic Stroke
 Because of reduced mortality rates, the number of stroke survivors who are
non-institutionalized increased from 2.0 to 2.4 million between 1980 and
1991.
MEDTAP International 2004, The Value of Investment in Health Care
Cardiovascular Disease: Heart Disease and Stroke
The Economic Value
 For every dollar spent on cardiovascular medical treatments, a return of $4
is realized.
Cutler 2004, Your Money or Your Life?
 The value of a 10% reduction in mortality from cardiovascular disease
equals $5,725 billion in 2004 dollars.
Murphy and Topel 2005, The Value of Health and Longevity
 During the 1970s and 1980s, the gains associated with the prevention and
treatment of cardiovascular disease totaled $31 trillion.
The Lasker Foundation 2000, Exceptional Returns
 Between 1984 and 1998, the cost of treating heart attack patients rose
$10,000. However, medical technology increased the life expectancy of
heart attack patients by an average of one year—a value of $70,000 and a
net benefit of $60,000.
Cutler and McClellan 2001, Is Technological Change in Medicine Worth It?
Cardiovascular Disease: Heart Disease and Stroke
The Economic Value
 Every $1 spent on technological innovations in heart attack care has
produced an estimated $7 gain.
Cutler and McClellan 2001, Is Technological Change in Medicine Worth It?
 Coronary stenting costs $15,000—significantly less than the $27,000 cost
of open bypass surgery.
AdvaMed, Medical Technology: Saves and improves lives
 Performing renal angioplasty to unclog arteries costs $6,000 less than
performing a surgical bypass operation. When post-procedure costs are
factored in, it costs $14,000 less. The performance of renal angioplasty
also takes an average of three hours less than bypass surgery and reduces
hospital stays by over two weeks.
Xue et al. 1999, Outcome and Cost Comparison of Percutaneous Transluminal Renal Angioplasty, Renal
Arterial Stent Placement, and Renal Arterial Bypass Grafting
Cardiovascular Disease: Heart Disease and Stroke
The Economic Value
 Every additional dollar spent on the routine use of beta-blockers (versus
under-use) in acute heart attack patients has produced health gains valued
as high as $38.44.
MEDTAP International 2004, The Value of Investment in Health Care
 According to the National Institutes of Health, use of the clot-busting drug
t-PA saves $4,400 per patient in hospitalization and nursing home costs..
Houston 2004, Innovative Drugs Cost Patients Less in the Long Run
 Use of ACE inhibitor drugs for people with congestive heart failure helped
avoid $9,000 per person in hospital costs over a three-year period and
reduced deaths by 16%.
The SOLVD Investigators 1991, Effect of Enalapril
Cardiovascular Disease: Heart Disease and Stroke
The Economic Value
 A year-long study of patients with congestive heart failure found that
increased use of medicines increased pharmaceutical costs by 60%;
however, hospital costs declined by 78%, producing a net savings of $9.3
million. The ability of patients to perform activities of daily living went up
15% and the death rate dropped from an expected 25% to 10%.
Managed Healthcare 1998, Provide Education About Congestive Heart Failure and Pump Up Your Savings
 Spending $1,000 per year on anticoagulants can save $100,000 in hospital
costs for care of a person disabled by a stroke.
Giorgianni, Grana, and Scipioni 2001, Global Impact of Innovations on Chronic Disease in the Genomics
Era
Cardiovascular Disease: Heart Disease and Stroke
The Economic Value
 Every additional dollar spent on antiplatelet therapy versus aspirin for the
prevention of stroke in high-risk patients has produced health gains valued
between $2 and $6.
MEDTAP International 2004, The Value of Investment in Health Care
 Every additional dollar spent on the overall treatment of stroke has
produced health gains valued at $1.55.
MEDTAP International 2004, The Value of Investment in Health Care
Cardiovascular Disease: Heart Disease and Stroke
The Future Value
 Development and widespread use of left ventricular assist devices could
result in a 50% decrease in heart failure–related hospitalizations.
Shekelle et al. 2000, Identifying Potential Health Care Innovations for the Elderly of the Future
 Initiating and continuing beta-blocker use in most first-time heart attack
survivors for 20 years would result in 72,000 fewer coronary heart disease
deaths, 62,000 fewer heart attacks, and 447,000 gained life-years.
Additionally, it would save up to $18 million.
Phillips et al. 2000, Health and Economic Benefits of Increased Beta-Blocker Use
 The projected economic value of eliminating deaths from heart disease is
approximately $48 trillion.
Murphy and Topel 2003, Measuring the Gains from Medical Research
 Widespread use of pacemaker/defibrillators to control atrial fibrillation
could result in a 50% decrease in stroke.
Shekelle et al. 2000, Identifying Potential Health Care Innovations for the Elderly of the Future
Cardiovascular Disease: Heart Disease and Stroke
The Future Value
 Development of a neuroprotective drug could potentially reduce disability
from stroke by 50%.
Goldman et al. 2005, Consequences of Health Trends and Medical Innovation for the Future Elderly
 Treating acute stroke with drugs that minimize cell death could result in a
median decrease in disability of 30%. Treatment with stem cell transplants
could result in a median decrease in disability of 25.
Shekelle et al. 2000, Identifying Potential Health Care Innovations for the Elderly of the Future
 The projected economic value of eliminating deaths from stroke is $7.6
trillion.
Murphy and Topel 2003, Measuring the Gains from Medical Research
 Greater use of clot-busting drug t-PA in ischemic stroke patients could
save the health care system over $100 million a year.
National Institute of Neurological Disorders and Stroke 1998, New Stroke Treatment Likely to Decrease
Health Care Costs and Increase Quality of Life
Diabetes
The Human Value
 A study by the Diabetes Prevention Program found that the use of the drug
metformin by high-risk patients reduced the risk of development of type 2
diabetes by 31% .
National Diabetes Information Clearinghouse, Diabetes Prevention Program
 Blood pressure control in diabetics reduces the risk of cardiovascular
disease by 33% to 50%, and the risk of microvascular complications by
approximately 33%.
Centers for Disease Control and Prevention 2005, National Diabetes Fact Sheet
 Detection and treatment of diabetic eye disease with laser therapy can
reduce development of severe vision loss by an estimated 50% to 60%..
Centers for Disease Control and Prevention 2005, National Diabetes Fact Sheet
Diabetes
The Economic Value
 The value of a 10% reduction in mortality from diabetes is $486 billion in
2004 dollars.
Murphy and Topel 2005, The Value of Health and Longevity
 Every additional dollar spent on the overall treatment of type 2 diabetes
has produced health gains valued at $1.49.
MEDTAP International 2004, The Value of Investment in Health Care
 Laser treatments save up to $1.6 billion per year through prevention and
treatment of blindness in diabetics.
Research!America 2005, Investment in Research Saves Lives and Money
 Every additional dollar spent on intensive blood glucose control for newly
diagnosed type 2 diabetic patients has produced health gains valued at
$3.77.
MEDTAP International 2004, The Value of Investment in Health Care
Diabetes
The Economic Value
 Every additional dollar spent on screening and treating diabetic eye disease
in type 2 diabetics on insulin has produced health gains valued at $36.
MEDTAP International 2004, The Value of Investment in Health Care
 Every additional dollar spent on statin therapy for diabetes patients without
cardiovascular disease has produced health gains valued between $7 and
$31.
MEDTAP International 2004, The Value of Investment in Health Care
Diabetes
The Future Value
 Widespread use of diabetes prevention drugs that enhance insulin
sensitivity could result in a 50% prevention of type 2 diabetes over a 10–15
year period.
Shekelle et al. 2000, Identifying Potential Health Care Innovations for the Elderly of the Future
 One economic model predicts that if type 1 and type 2 diabetics had begun
Captopril (a drug that controls blood pressure and delays the onset of
kidney failure) treatment in 1995, the aggregate health care cost savings in
1999 would have been $189 million and in 2004 would have been $475
million—a present value cumulative cost savings of $2.4 billion for those
10 years.
Rodby, Firth, and Lewis 1996, An Economic Analysis of Captopril in the Treatment of Diabetic Nephropathy
Diabetes
The Future Value
 The U.S. could save up to $2.5 billion by preventing diabetes-related
hospitalizations. Much of these savings would come from Medicare with
preventable hospital costs of $1.3 billion, and Medicaid with preventable
hospital costs of $386 million .
Agency for Healthcare Research and Quality 2005, Economic and Health Costs of Diabetes
 Shifting to home-based dialysis could save between $750 million and $1.6
billion in health care costs .
AdvaMed 2001, Cost of Diabetes, Promise of New Technologies
Neurological Disease: Alzheimer’s and Parkinson’s Disease
The Human Value
 A recent study showed that memantine, a medicine approved to treat
moderate-to-severe Alzheimer’s, significantly slows cognitive decline and
reduces the need for caregiving by 45.8 hours per month.
Reisberg et al. 2003, Memantine in Moderate-to-Severe Alzheimer’s Disease
 Donepezil, a cholinesterase inhibitor, has been found to slow progression
of Alzheimer’s disease in its early stages, delaying the need for nursing
home care by an average of 30 months .
Provenzano et al. 2001, Delays in Nursing Home Placement for Patients with Alzheimer’s Disease
Associated with Donepezil May Have Care Cost Saving Implications
 Deep brain stimulation, an electrical signal delivered deep inside the brain,
provides significant symptomatic relief for Parkinson’s patients whose
medication is no longer effective.
Parkinson’s Action Network, About Parkinson’s Disease
 Electrical stimulation of a portion of the thalamus, guided with MRI, can
rapidly and dramatically reduce tremors from Parkinson’s.
AdvaMed, Medical Technology and Assistive Devices
Neurological Disease: Alzheimer’s and Parkinson’s Disease
The Economic Value
 Research shows that use of donepezil leads to a four-fold increase in drug
costs; however, it significantly lowers overall medical costs, reducing
medical treatment and prescription drug costs by $3,891 per patient, per
year.
Hill et al. 2002, The Effect of Donepezil Therapy on Health Care Costs in a Managed Care Plan
 A clinical trial in Europe found that treating Alzheimer’s patients with an
Alzheimer’s drug reduced annual treatment costs by $1,000 per patient.
PhRMA Japan 2000, Aricept Reduces Annual Treatment Cost
 Galantamine, a cholinesterase inhibitor, delays Alzheimer’s patients’ need
for full-time care, with overall cost savings estimated between $323 and
$4,256 per patient.
Caro et al. 2003, Rational Choice of Cholinesterase Inhibitor for the Treatment of Alzheimer’s
Neurological Disease: Alzheimer’s and Parkinson’s Disease
The Economic Value
 Positron emission tomography (PET) is an effective tool in detecting and
monitoring Parkinson’s disease. Because it can eliminate the need for
other, more invasive diagnostic procedures and detect the disease earlier, it
also significantly reduces health care costs .
AdvaMed, Medical Technology and Assistive Devices
 In one study, deep-brain stimulation for Parkinson’s patients significantly
reduced their required dosages of antiparkinsonian medications,
consequently decreasing their medication costs by 32% one year after
surgery, and 39% two years after .
Charles et al. 2004, Deep Brain Stimulation of the Subthalamic Nucleus Reduces Antiparkinsonian
Medication Costs
Neurological Disease: Alzheimer’s and Parkinson’s Disease
The Future Value
 Use of existing or new drugs/compounds for Alzheimer’s prevention could
result in a delay of onset of between two and five years.
Shekelle et al. 2000, Identifying Potential Health Care Innovations for the Elderly of the Future
 Delaying the onset of Alzheimer’s by only five years could reduce the
number of people with Alzheimer’s by almost 50% after 50 years.
Brookmeyer, Gray, and Kawas 1998, Projections of Alzheimer’s Disease in the United States and the Public
Health Impact of Delaying Disease Onset
 Delaying the onset and progression of the disease would reduce the
projected number of people with moderate to severe cases of the disease to
4.4 million instead of 10.3 million in 2050.
The Lewin Group 2004, Saving Lives, Saving Money
 Delaying the onset of Alzheimer’s disease by just five years could save
$50 billion per year.
Alzheimer’s Association
Neurological Disease: Alzheimer’s and Parkinson’s Disease
The Future Value
 Research breakthroughs that slow the onset and progression of
Alzheimer’s disease could achieve annual Medicare savings of $51 billion
by 2015, $126 billion by 2025, and $444 billion by 2050 .
The Lewin Group 2004, Saving Lives, Saving Money
 A $1 billion-investment in Alzheimer’s research that led to research
breakthroughs by 2010 could have a 10-to-1 return by 2015, and a 90-to-1
return by 2050 .
The Lewin Group 2004, Saving Lives, Saving Money
 Based on rates of admission in 1998, delaying admission of Alzheimer’s
patients to nursing homes by one month could save as much as $1.12
billion a year .
Leon, Cheng, and Neumann 1998, Alzheimer’s Disease Care
Neurological Disease: Alzheimer’s and Parkinson’s Disease
The Future Value
 In one study, despite a four-fold increase in prescription drug spending,
overall health spending for Alzheimer’s patients undergoing drug therapy
went down by one-third .
Hill et al. 2002, The Effect of Donepezil Therapy on Health Costs in a Medicare Managed Care Plan
 Researchers have found how to manipulate embryonic stem cells to form
dopamine-producing brain cells. This new source of cells could someday
be used to replace cells lost to Parkinson’s .
Perrier et al. 2004, Derivation of Midbrain Dopamine Neurons from Human Embryonic Stem Cells
 According to one Parkinson’s expert, a 10% slowing of Parkinson’s
disease progression would save $327 million per year.
Parkinson’s Action Network, About Parkinson’s Disease
 Nineteen new medicines are currently in development for the treatment of
Parkinson’s disease.
PhRMA, New Medicines in Development Database